Long-term relapses after 12-month treatment for Mycobacterium kansasii lung disease

Santín, Miguel; Dorca, Jordi; Alcaide, Fernando; Gonzalez, Leah C.; Casas, Susana; Lopez, Marie; Guerra, Michele

doi:10.1183/09031936.00024008

Cited by 41 publications

(31 citation statements)

References 19 publications

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“…Fortunately, there are no negative therapeutic consequences in case of M. kansasii infections misdiagnosed as M. tuberculosis following a positive IGRA test, as this strain is usually sensitive to standard anti-tuberculous therapy [21,29]; however, the recommended duration of treatment is 18 months [30,31]. In contrast, if infections due to M. szulgai, M. gordonae, M. flavescens or M. marinum are misdiagnosed as tuberculosis due to a positive IGRA test, this can have deleterious therapeutic consequences as these SGM NTMs are resistant to standard anti-tuberculous therapy [32,33].…”

Section: Discussionmentioning

confidence: 99%

Uveitis with occult choroiditis due to Mycobacterium kansasii: limitations of interferon-gamma release assay (IGRA) tests (case report and mini-review on ocular non-tuberculous mycobacteria and IGRA cross-reactivity)

2012

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Ocular tuberculosis is difficult to diagnose but should be suspected when uveitis fails to respond to inflammation suppressive therapy. Interferon-gamma release assays (IGRAs) represent a substantial help to diagnose suspected ocular tuberculosis especially in non-endemic areas. Indocyanine green angiography (ICGA) is able to detect clinically silent choroiditis that, when associated with a positive IGRA test, should lead the clinician to suspect ocular tuberculosis, warranting specific therapy. The fact that IGRA tests can also react with some atypical strains of mycobacteria is not always known. We report here a case with resistant post-operative inflammation that presented with occult ICGA-detected choroiditis and a positive IGRA test that was most probably due to the nontuberculous mycobacterium (NTM) Mycobacterium kansasii. A 66 year-old man presented with a resistant cystoid macular oedema (CMO) in his left eye after combined cataract and epiretinal membrane surgery. At entry, his best-corrected visual acuity (BCVA) was 0.5 for far and near OS. Intraocular inflammation measured by laser flare photometry was elevated in the left eye (54.4 ph/ms) and also in the right eye (50.9 ph/ms). Four subTenon's injections of 40 mg of triamcinolone did not produce any substantial improvement. Therefore a complete uveitis work-up was performed. Fluorescein angiography showed CMO OS and ICGA showed numerous hypofluorescent dots and fuzziness of choroidal vessels in both eyes. Among performed laboratory tests, the Quanti-FERON Ò -TB Gold test was positive. After a pulmonological examination disclosing a right upper lobe infiltrate, the patient was started on a triple antituberculous therapy. Bronchial aspirate, obtained during bronchoscopy, was Ziehl-positive and culture grew M. kansasii. Nine months later, BCVA OS increased to 1.0 and flare decreased to 40.2 ph/ms. The CMO OS resolved angiographically and did not recur with a macula still slightly thickened on OCT. Suspected ocular tuberculosis based on clinical findings and a positive IGRA test can, in rare instances, be due to atypical mycobacteria that also produce positive IGRA tests such as M. kansasii, M. szulgai, M. gordonae, M. flavescens and M. marinum. In our case failure to 123Int Ophthalmol (2012) 32:499-506 DOI 10.1007 isolate the atypical mycobacterium would not have had negative therapeutic consequences, as M. kansasii is sensitive to the standard anti-tuberculous treatments, which is not the case with other NTMs.

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Section: Discussionmentioning

confidence: 99%

Uveitis with occult choroiditis due to Mycobacterium kansasii: limitations of interferon-gamma release assay (IGRA) tests (case report and mini-review on ocular non-tuberculous mycobacteria and IGRA cross-reactivity)

2012

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“…Fortunately, M. kansasii is among the most antibiotic-responsive NTM species with a low rate of treatment failure or relapse (<1%) among patients who completed the ATS/IDSA recommended treatment of daily isoniazid, rifampin, and ethambutol until cultures are negative for at least 12 months (Table 3) (29). Rifampin is the most important agent in this regimen as cure was uncommon in the pre-rifampin era (61). …”

Section: Treatment For M Kansasiimentioning

confidence: 99%

“…Patients receiving shorter courses (9 to 12 months) with different regimens have experienced unacceptable rates of relapse (6–10%) (65, 66). Earlier regimens also included streptomycin in the first three months (61, 67) but since high cure rates are typically achieved with oral regimens, aminoglycosides are rarely necessary. For rifampin-resistant M. kansasii , ATS/IDSA recommends a combination of clarithromycin, moxifloxacin, and a third agent with in vitro susceptibility such as ethambutol or sulfamethoxazole (29).…”

Section: Treatment For M Kansasiimentioning

confidence: 99%

Treatment of Non-Tuberculous Mycobacterial Lung Disease

Philley

DeGroote

Honda

et al. 2016

Curr Treat Options Infect Dis

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Opinion Statement Treatment of non-tuberculous mycobacterial lung disease (NTM-LD) is challenging for several reasons including the relative resistance of NTM to currently available drugs and the difficulty in tolerating prolonged treatment with multiple drugs. Yet-to-be-done, large, multicenter, prospective randomized studies to establish the best regimens will also be arduous because multiple NTM species are known to cause human lung disease, differences in virulence and response to treatment between different species and strains within a species will make randomization more difficult, the need to distinguish relapse from a new infection, and the difficulty in adhering to the prescribed treatment due to intolerance, toxicity, and/or drug-drug interactions, often necessitating modification of therapeutic regimens. Furthermore, the out-of-state resident status of many patients seen at the relatively few centers that care for large number of NTM-LD patients pose logistical issues in monitoring response to treatment. Thus, current treatment regimens for NTM-LD is largely based on small case series, retrospective analyses, and guidelines based on expert opinions. It has been nearly 10 years since the publication of a consensus guideline for the treatment of NTM-LD. This review is a summary of the available evidence on the treatment of the major NTM-LD until more definitive studies and guidelines become available.

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“…It has been reported in up to 6.6% of patients who were reportedly compliant with their treatment and in whom mycobacterial resistance did not developed. 15 …”

Section: Discussionmentioning

confidence: 97%

Progressive Shortness of Breath in a 74-Year-Old Man

Al-Obaidi¹,

Mahasneh²,

Khasawneh³

2015

Infectious Diseases in Clinical Practice

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A 74-year-old Hispanic male presented with several weeks of progressive shortness of breath and dry cough. He reported poor appetite and weight loss. He denied fever, chills, or night sweats. He also denied vomiting, diarrhea, or dysuria.Physical examination showed a cachectic male. Vital signs included temperature of 97.6°F, blood pressure of 109/61 mm Hg, heart rate of 89 beats per minute, and a respiratory rate of 22 breaths per minute. His lung examination revealed crackles, and his heart examination showed normal heart sounds with no murmurs or gallops. His abdomen was soft and nontender, and there was no organomegaly. He had no rash or lymphadenopathy.Laboratory results showed white blood cell count of 7.3 Â 10 9 /L and hemoglobin of 8.6 g/dL. Serum creatinine level was 1.9 mg/dL. A transthoracic echocardiogram showed normal ejection fraction of 50%. Chest x-ray showed nonspecific bilateral alveolar opacities. Computed tomography (CT) scan of the chest is shown in Figure 1. Computed tomography-guided biopsy was performed (Figs. 2,3).What is your Diagnosis? DISCUSSIONChest CT scan showed left upper lobe thick wall cavity with bilateral effusions and ground glass opacities. Tuberculosis was suspected. Hence, he was placed in airborne precautions, and sputum samples for acid-fast bacilli staining as well as CT-guided biopsy were performed. The sputum acid-fast staining was positive. The biopsy showed caseating granulomas composed of epitheloid histiocytes and lymphocytes with central necrosis. Acid-fast bacilli stain showed small clusters and single acid-fast bacilli. The previously described was consistent with mycobacterial lung infection. He was started on antituberculosis medication. Three weeks later, his sputum as well as his lung biopsy grew mycobacteria. Using polymerase chain reaction testing, it was identified as Mycobacterium kansasii. His treatment was changed to rifampin, ethambutol, isoniazid, and pyridoxine. His sputum culture turned negative after 3 months of therapy. He finished 18 months of therapy with complete resolution of symptoms.Nontuberculous mycobacteria (NTM) refer to all mycobacterium species other than Mycobacterium tuberculosis (MTB) complex and Mycobacterium leprae. 1 They are environmental organisms that are abundant in soil and water. 2 They are notorious for being resistant to chemical disinfectants and ultraviolet irradiation used in water treatment processes. 3 Although this heterogeneous group is bundled under one name "NTM," species vary in its clinical relevance and the virulence factors they possess. 4 The pathogenicity of this group of bacteria is low; M. kansasii is considered to be the most virulent. 5 It has 5 to 7 subspecies. Subtype I is the predominant among clinical isolates and is the most responsible for human infections. 5 Mycobacterium kansasii causes a wide array of illnesses, with pulmonary infections being the most common.The prevalence of NTM infections is rising, and there is an obvious diversity in its geographical distribution. 6 Mycobacterium avium co...

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Long-term relapses after 12-month treatment for Mycobacterium kansasii lung disease

Cited by 41 publications

References 19 publications

Uveitis with occult choroiditis due to Mycobacterium kansasii: limitations of interferon-gamma release assay (IGRA) tests (case report and mini-review on ocular non-tuberculous mycobacteria and IGRA cross-reactivity)

Uveitis with occult choroiditis due to Mycobacterium kansasii: limitations of interferon-gamma release assay (IGRA) tests (case report and mini-review on ocular non-tuberculous mycobacteria and IGRA cross-reactivity)

Treatment of Non-Tuberculous Mycobacterial Lung Disease

Progressive Shortness of Breath in a 74-Year-Old Man

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